Is it OK to go to work the day after having anesthesia

brownbook · Apr 12, 2016

Any drug given by an anesthesiologists or CRNA can be called "anesthesia". From a one time dose of 50 mg of propofol, the patient has an IV, no other drugs given, a nasal cannula, is sent home 1/2 hour later. To a 1.5 inspired concentration of isoflurane (that is way above my pay grade, have no idea what "dosage" of isoflurane is used?) the patient is intubated, various other IV drugs are used, the patient most likely would stay the night, or several nights.

So yes, the first patient's discharge instructions will say may return to work in 24 hours, (ours do.) So technically if you got the anesthesia at 8:00 am you should not drive or return to work until after 8:00 am the next day.

Geeze....legally I suppose if something happened at 7:30 the next day what????? A lawyer or police could say you were under the influence of anethesia? Yeah I guess they could.

Every body metabolized every drug differently. Most average, healthy, adults, can, should, will, return to normal activities the "next" day, even if they received 200 mg of propofol and some versed and fentanyl at 5:00 pm. The next day could be 12 to 16 hours after the procedure.

I guess in a perfect world every discharge instruction sheet would say "you should be able to return to normal activities tomorrow, let how you feel be your guide." But even that leave a lot of room for lawyers to play with!

I heard about a patient who had a colonoscopy, she asked the GI Dr. (who is Mr. unpleasant) if she could be off work the next day. He had a fit and said absolutely not!

NurseSpeedy, ADN, LPN, RN · Apr 13, 2016

Every body metabolized every drug differently. Most average, healthy, adults, can, should, will, return to normal activities the "next" day, even if they received 200 mg of propofol and some versed and fentanyl at 5:00 pm. The next day could be 12 to 16 hours after the procedure.
I guess in a perfect world every discharge instruction sheet would say "you should be able to return to normal activities tomorrow, let how you feel be your guide."

I definitely agree with this. I had simple IV sedation for having my wisdom teeth removed when I was 18 years old and have very little memory of what happened over the course of the next three days. I remember stumbling from the bedroom to the bathroom a few times but that's about it.

Fast forward to age 31 when I had orthopedic surgery where I received a whole lot more medication (general anesthesia). Aside from the fact that I was not able to walk for a couple of months without crutches, I felt perfectly cognoscente and if I had a desk job I would have been okay to go in for a few hours (until I swelled up and needed pain medication) later that evening. Of course the whole reason why I broke my foot was because I had a stress fracture from running to fast, too often, for too long. I was conditioned like an athlete and I metabolized everything pretty fast. The 'block' that was supposed to wear off in the middle of the night was given at 7 or 8 am and had worn off suddenly by 10:30am. I was not a happy camper because I had not taken anything for pain, thinking that I wouldn't need to take anything until bedtime.

roser13, ASN, RN · Apr 13, 2016

For 24 hours after general anesthesia, you are not considered to be a legal adult. You may not sign legal documents, sign a check, supervise children or in general be considered a legal adult? For IV/MAC anesthesia, the rules are a little more relaxed. The issue then becomes one of whether narcotics are in play post-op, due to the surgery/procedure.

KatieMI, BSN, MSN, RN · Apr 13, 2016

100% question to whoever provided the anesthesia, while keeping in mind that everybody is different and that "just a Vicodin for pain" still considered to be "an influence".

There may be way more factors than anesthesia drugs. If a patient got nothing than 50 mcg of fentanyl plus local for mole excision but also phenegran and haloperidol for opioid-induced nausea, he can be impaired for much longer than that fentanyl is supposed to act. If patient had good ol' bowel prep for colonoscopy done yesterday and still has a bit of residual diarrhea, I would not allow him to do anything cutting him off restroom, such as driving. If patient received high-dose steroid (such as some people with h/o angioedema and severe allergies), he may experience "steroid high" for good 72 hours after loading. I really doubt that something signed at that time could be seen as ok from legal point of view ('been there, had that).

The key is to let everybody know if something, anything at all "unusual" ever happened with patient or anybody of his/her blood relatives pertaining to anesthesia and drugs in general. If nothing ever happened or known, it is generally safe, if no renal/hepatic disfunction, to count for at least 4 1/2 half-life periods of the ACTIVE drug to pass before considering its action (s) done and gone (accounting for that, for example, codeine takes at least 1 hour and usually longer to be converted into its active component, morphine).

Anonymous865 · Apr 13, 2016

For 24 hours after general anesthesia, you are not considered to be a legal adult. You may not sign legal documents, sign a check, supervise children or in general be considered a legal adult? For IV/MAC anesthesia, the rules are a little more relaxed. The issue then becomes one of whether narcotics are in play post-op, due to the surgery/procedure.

Laws vary from state to state.

In my state this is absolutely not true.

The advice given by the hospital is that you are advised not to sign anything or make important decisions, because you may still be under the effects of the anesthesia for 24 hours. The law certainly does NOT consider you to be incompetant just because you have had anesthesia. You may legally sign anything you want and supervise children. The advise given on the paperwork from the hospital is nothing more than a CYA for the hospital so no one will sue them.

This is no different than the warning on every single prescription that someone gets that the drug may cause drowsiness and you shouldn't drive or operate machinery until you know how you react. It is just like the warning that your cup of coffee may be hot and you should avoid getting it on you to avoid burns.

Anonymous865 · Apr 13, 2016

As far as the question of whether you can be considered "under the influence" if you have had anesthesia, narcotics, etc. within a certain amount of time? In my state the answer is "No."

The determination of whether someone is "under the influence" is based on either blood alcohol content (for alcohol) or field sobriety test for other drugs. If you are steady on your feet, not slurring your words, can answer the officer's questions, etc., you are not "under the influence" even if you just had anesthesia or a narcotic.

Penelope_Pitstop, BSN, RN · Apr 13, 2016

For 24 hours after general anesthesia, you are not considered to be a legal adult. You may not sign legal documents, sign a check, supervise children or in general be considered a legal adult? For IV/MAC anesthesia, the rules are a little more relaxed. The issue then becomes one of whether narcotics are in play post-op, due to the surgery/procedure.

Fun fact - the Vice President obtains "presidential powers" while the Commander in Chief is undergoing a colonoscopy, and for a bit thereafter...although that is only MAC anesthesia.

There's more to the process, but Prez Obama had a virtual colonoscopy and didn't need to do this.

calivianya, BSN, RN · Apr 13, 2016

I had an EGD done two years ago and I was 100% back to normal within 30 minutes of the procedure ending. I was even annoyed that I had taken a taxi there in the first place instead of driving myself - not that they would have let me drive myself home, but I would have been fine if I could have.

What sort of shape you're in after the procedure really depends on what type of anesthesia you got. They just gave me IV fentanyl and propofol - stuff that's not going to hang around long, so it wore off very quickly for me. There are things that hang around longer. Sedation doesn't automatically mean you're going to be impaired for 24 hours, but the hospital has to tell you that for liability purposes.

Horseshoe, BSN, RN · Apr 13, 2016

I work in endo, and we give propofol/fentanyl, and sometimes just propofol. We advise patients that they should not drive, consume alcohol, or sign legal documents that same day, but that the following day they should be fine to engage in their normal activities. We do not tell them not to work for 24 hours after the procedure. Our last case at 3:30 is given the same advice as the 7:30 case: "you can drive, work, and do your normal activities tomorrow."

As for getting into an accident within 24 hours: there is no blanket DUI charge based simply on the fact that the driver had anesthesia within 24 hours. They would have to prove that the driver was impaired, either by failing a sobriety test or testing over the threshold via blood work.

guest825264 · Jun 24, 2016

OK here is an update on the anesthesia question. I was scheduled for a scope d/t bleeding at 11am, I waited until 1600 to actually have the procedure d/t the facility running behind. I had a real hard time waking up after the procedure. I called off work since I was having trouble and needed to give them enough time to find someone to fill in. The next day I slept all day. I don't know why my body and mind reacted the way it did, but I do know that it is a good thing I did not take charge of patients the next day. They deserve a nurse that is alert, aware and able to make good decisions. I was compromised and I am glad I called off. Some people may be just fine the day after a procedure; but, you can't always count on how your fast your body will clear the meds.

Horseshoe, BSN, RN · Jun 24, 2016

OK here is an update on the anesthesia question. I was scheduled for a scope d/t bleeding at 11am, I waited until 1600 to actually have the procedure d/t the facility running behind. I had a real hard time waking up after the procedure. I called off work since I was having trouble and needed to give them enough time to find someone to fill in. The next day I slept all day. I don't know why my body and mind reacted the way it did, but I do know that it is a good thing I did not take charge of patients the next day. They deserve a nurse that is alert, aware and able to make good decisions. I was compromised and I am glad I called off. Some people may be just fine the day after a procedure; but, you can't always count on how your fast your body will clear the meds.

Do you know what meds you were given?

My endoscopy patients who receive propofol only wake up much faster and recover more fully by the time I discharge them than the patients who receive combinations of propofol and narcotics or versed.

PS-that's really crappy that your procedure was delayed by 5 hours!